Swallowing exercises

  • 文章类型: Journal Article
    目的:我们旨在评估声音训练在接受放疗的头颈部肿瘤患者中的效果。
    方法:本研究采用随机对照试验设计。采用IBMSPSS26.0将74例患者随机分为对照组和实验组。对照组遵循吞咽锻炼计划,实验组额外接受ABCLOVE语音训练。两种训练方案在整个放射治疗周期中持续进行。我们比较了标准化吞咽评估(SSA),最大发声时间(MPT),语音障碍指数-10,以及张口困难等并发症的发生率,营养不良,和两组在T1时的误吸(0次放疗,放疗前),T2(15-16次放射治疗,放射治疗的中间),和T3(30-32次放射治疗,放射治疗结束)。
    结果:70名参与者完成了这项研究。两组患者吞咽功能、MPT组间及交互作用差异均有统计学意义(P<0.05)。放疗结束时(T3),实验组的SSA评分(20.77±1.96)和MPT(10.98±1.75)s优于对照组(SSA:22.06±2.38和MPT:9.49±1.41s),具有统计学意义(P<0.05)。此外,实验组营养不良和误吸发生率低于对照组(P<0.05)。
    结论:语音训练可以改善头颈部肿瘤患者的吞咽功能和MPT,减少与吞咽障碍相关的并发症。
    OBJECTIVE: We aimed to evaluate the effect of voice training in patients with head and neck cancer who were undergoing radiotherapy.
    METHODS: This study used a randomized controlled trial design. IBM SPSS 26.0 was used to randomly divide 74 patients into a control group and an experimental group. The control group followed a swallowing exercises program, and the experimental group additionally received ABCLOVE voice training. Both training programs continued throughout the entire radiotherapy cycle. We compared standardized swallowing assessment (SSA), maximum phonation time (MPT), the Voice Handicap Index-10, and incidence of complications such as difficulty opening the mouth, malnutrition, and aspiration between the two groups at T1 (0 radiotherapy sessions, before radiotherapy), T2 (15-16 radiotherapy sessions, middle of radiotherapy), and T3 (30-32 radiotherapy sessions, end of radiotherapy).
    RESULTS: 70 participants completed this study. Swallowing function and MPT intergroup and interaction effects were statistically significant between the two groups (P < 0.05). At the end of radiotherapy (T3), the SSA score (20.77 ± 1.96) and MPT (10.98 ± 1.75) s in the experimental group were superior to those in the control group (SSA: 22.06 ± 2.38 and MPT: 9.49±1.41 s), with statistical significance (P<0.05). Moreover, the incidence of malnutrition and aspiration in the experimental group was lower than that in the control group (P < 0.05).
    CONCLUSIONS: Voice training can improve swallowing function and MPT and reduce complications related to swallowing disorders in patients with head and neck cancer.
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  • 文章类型: Journal Article
    老年人在急性住院期间经常发生吞咽困难。导致营养摄入减少,增加了脆弱,和各种社会心理挑战。这项随机对照研究旨在评估两种干预措施的效果,增稠剂和吞咽练习,精神上的幸福,身体活动,以及2019年10月至2020年8月急性住院期间吞咽困难的老年成年患者的幸福感。样本量计算采用保守估计方法,导致42名参与者的估计所需样本量。抽样方法是随机整群抽样方法,三个病房分配给增稠剂组,吞咽练习组和对照组,分别。使用1:1:1的分层随机分配将72名参与者分配到干预组(增稠剂或吞咽运动)或对照组。在干预前后收集数据,并使用t检验对匹配的样本进行分析,方差分析,和统计分析的广义估计方程。两个干预组均显示精神幸福感显着改善(p<0.001),身体活动(p<0.001),与对照组相比,幸福感(p<0.001)。然而,干预组之间无显著差异.我们的研究结果表明,涉及增稠剂和吞咽练习的干预措施对精神健康有积极影响,身体活动,以及急性住院期间吞咽困难的老年患者的幸福感,并强调实施这些干预措施对提高这一脆弱患者人群的整体健康和生活质量的重要性。
    Swallowing difficulties often occur in older adult patients during acute hospitalization, leading to reduced nutritional intake, increased frailty, and various psychosocial challenges. This randomized controlled study aimed to assess the effects of two interventions, thickeners and swallowing exercises, on the spiritual well-being, physical activity, and happiness of older adult patients with swallowing difficulties during acute hospitalization from October 2019 to August 2020. Sample size calculation was performed using a conservative estimate approach, resulting in an estimate-required sample size of 42 participants. The sampling method was a random cluster sampling approach, with three ward rooms assigned to the thickeners group, swallowing exercises group and control group, respectively. Seventy-two participants were assigned to the intervention groups (thickeners or swallowing exercises) or the control group using a 1:1:1 stratified random assignment. Data were collected before and after the intervention, and matched samples were analyzed using t-tests, ANOVA, and generalized estimating equations for statistical analysis. Both intervention groups showed significant improvements in spiritual well-being (p < 0.001), physical activity (p < 0.001), and happiness (p < 0.001) compared to the control group. However, there were no significant differences between the intervention groups. Our findings suggest that interventions involving thickeners and swallowing exercises have positive effects on the spiritual well-being, physical activity, and happiness of older adult patients with swallowing difficulties during acute hospitalization and emphasize the importance of implementing these interventions to enhance the overall well-being and quality of life of this vulnerable patient population.
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  • 文章类型: Multicenter Study
    背景:慢性放射相关吞咽困难(C-RAD)被认为是接受放射(RT)或放化疗(CRT)治疗的头颈部癌症幸存者中最严重的功能障碍之一。鉴于这些晚期毒性对患者健康和生活质量的主要影响,非常需要对吞咽困难进行循证管理.尽管研究报告了加强锻炼的好处,肌肉力量的变化转移到吞咽功能的变化通常仍然有限。因此,在C-RAD患者中,将孤立的加强锻炼与功能训练相结合可能会导致更大的功能增益。
    方法:这项三臂多中心随机试验旨在比较105例C-RAD患者单纯强化运动(第1组)与强化运动和功能性吞咽疗法(第2组)和非侵入性脑刺激的组合(第3组)的疗效和可能的去训练效果。在治疗之前和期间以及最后一次治疗后4周,将通过吞咽相关和强度测量以及生活质量问卷对患者进行评估。
    结论:总体而言,这项创新的RCT有望为C-RAD的康复提供新的见解,以优化治疗后的吞咽功能。
    背景:国际标准随机对照试验编号(ISRCTN)注册表IDISRCTN57028065。注册于2021年7月15日被接受。
    BACKGROUND: Chronic radiation-associated dysphagia (C-RAD) is considered to be one of the most severe functional impairments in head and neck cancer survivors treated with radiation (RT) or chemoradiation (CRT). Given the major impact of these late toxicities on patients\' health and quality of life, there is a strong need for evidence-based dysphagia management. Although studies report the benefit of strengthening exercises, transference of changes in muscle strength to changes in swallowing function often remains limited. Therefore, combining isolated strengthening exercises with functional training in patients with C-RAD may lead to greater functional gains.
    METHODS: This 3-arm multicenter randomized trial aims to compare the efficacy and possible detraining effects of mere strengthening exercises (group 1) with a combination of strengthening exercises and functional swallowing therapy (group 2) and non-invasive brain stimulation added to that combination (group 3) in 105 patients with C-RAD. Patients will be evaluated before and during therapy and 4 weeks after the last therapy session by means of swallowing-related and strength measures and quality of life questionnaires.
    CONCLUSIONS: Overall, this innovative RCT is expected to provide new insights into the rehabilitation of C-RAD to optimize post-treatment swallowing function.
    BACKGROUND: International Standard Randomized Controlled Trials Number (ISRCTN) registry ID ISRCTN57028065. Registration was accepted on 15 July 2021.
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  • 文章类型: Journal Article
    Poor patient adherence to swallowing exercises is commonly reported in the dysphagia literature on patients treated for head and neck cancer. Establishing the effectiveness of exercise interventions for this population may be undermined by patient non-adherence. The purpose of this study was to explore the barriers and facilitators to exercise adherence from a patient perspective, and to determine the best strategies to reduce the barriers and enhance the facilitators. In-depth interviews were conducted on thirteen patients. We used a behaviour change framework and model [Theoretical domains framework and COM-B (Capability-opportunity-motivation-behaviour) model] to inform our interview schedule and structure our results, using a content analysis approach. The most frequent barrier identified was psychological capability. This was highlighted by patient reports of not clearly understanding reasons for the exercises, forgetting to do the exercises and not having a system to keep track. Other barriers included feeling overwhelmed by information at a difficult time (lack of automatic motivation) and pain and fatigue (lack of physical capability). Main facilitators included having social support from family and friends, the desire to prevent negative consequences such as long-term tube feeding (reflective motivation), having the skills to do the exercises (physical capability), having a routine or trigger and receiving feedback on the outcome of doing exercises (automatic motivation). Linking these findings back to the theoretical model allows for a more systematic selection of theory-based strategies that may enhance the design of future swallowing exercise interventions for patients with head and neck cancer.
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  • 文章类型: Journal Article
    The incidence of head and neck cancer (HNC) in the UK is rising, with an average of 31 people diagnosed daily. Patients affected by HNC suffer significant short-term and long-term post-treatment morbidity as a result of dysphagia, which affects daily functioning and quality of life (QOL). Pretreatment swallowing exercises may provide additional benefit over standard rehabilitation in managing dysphagia after primary HNC treatments, but uncertainty about their effectiveness persists. This study was preceded by an intervention development phase to produce an optimised swallowing intervention package (SIP). The aim of the current study is to assess the feasibility of this new intervention and research processes within a National Health Service (NHS) setting.
    A two-arm non-blinded randomised controlled feasibility study will be carried out at one tertiary referral NHS centre providing specialist services in HNC. Patients newly diagnosed with stage III and IV disease undergoing planned surgery and/or chemoradiation treatments will be eligible. The SIP will be delivered pre treatment, and a range of swallowing-related and QOL measures will be collected at baseline, 1, 3 and 6 months post-treatment. Outcomes will test the feasibility of a future randomised controlled trial (RCT), detailing rate of recruitment and patient acceptance to participation and randomisation. Salient information relating to protocol implementation will be collated and study material such as the case report form will be tested. A range of candidate outcome measures will be examined for suitability in a larger RCT.
    Ethical approval was obtained from an NHS Research Ethics Committee. Findings will be published open access in a peer-reviewed journal, and presented at relevant conferences and research meetings.
    ISRCTN40215425; Pre-results.
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